Chemotherapy and terminal cancer patients

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With the death last week of Yale surgeon Dr. Sherwin Nuland, the New York Times obituary credited his 1993 best-selling book, “How We Die,” with being the catalyst that spurred many conversations about end-of-life care.

Yet 20 years later, many doctors still have a hard time initiating such conversations with their patients, especially those dying before their time from, say, metastatic cancer. Evidence of this comes from a troubling new Dana-Farber Cancer Institute study, which found that more than half of end-stage cancer patients receive chemotherapy during the last few months of their life, and those who received such treatment were more likely to die in a hospital intensive care unit, hooked to a ventilator, rather than at home as they would have preferred.

These patients were also less likely to have discussed their end of life wishes with their oncologist compared with other end-stage cancer patients who opted not to continue chemotherapy, according to the study of 386 terminally ill cancer patients published last Tuesday in the British Medical Journal.

“There’s a subtle dance that happens between oncologist and patient,” said study leader Dr. Alexi Wright, “where doctors don’t want to broach the subject of dying because it makes those patients think we’re giving up on them.”

She and her colleagues found that chemotherapy didn’t prolong survival but did increase the likelihood of a more medicalized death: 65 percent of those on cancer drugs died in their preferred place compared with 80 percent of those who stopped treatments.

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